Thursday, 4 March 2010

EBV specific killer cells in early MS

A new study looking into the immune response to EBV in people with MS has shown that a group of white blood cells responsible for killing EBV, the so called CD8+ cytotoxic lymphocytes or CTLs, are increased in theblood of people with early MS as compared to controls and other patients. Importantly these cells were shown to be increased in the spinal fluid of subjects with MS compared to subjects with other diseases. This data further strengthens the association between EBV and MS, in particular early disease.

Any view on when a definitive statement can be made about the role of EBV in MS? The link has been examined for some 30 years, but all we get is tantalising associations. Until there is a definitive link, there will be no incentive for research into treatments targetting EBV.

I also saw some recent research suggesting a link between Vit D and EBV - if you get enough Vit D, the EBV infection likely to be milder + kept at bay in later life.

A good start would be a recommendation on what level of Vit D to take (without the ususual caveat of more research required i.e. another 10-15 years). The MS docs need to take some informed risks to tackle this often devastating disease (rather than waiting for 100% definitive answers which MS research does not deliver). High Vit D supplementation in the teenage years would seem sensible as most get mono during this time.

PS this is not an attack on you Prof G, but against a research system which drip feeds results (EBV / MS research being a good example), and does not appear to be joined up (researchers all over the world doing a little bit of research in isolation).

Sorry for sounding stupid, but why do we modify (and sometimes wipe out) the immune system with the current MS drugs, given that some immune cells would appear to be targetting EBV? Or is it that the immune system response to EBV is too much which then causes inflammation and damage to the nervous system tissue? Another simple question - if we got rid of EBV from a person with MS would this have a favourable outcome i.e. reduce future disease activity?

Everyone seems to know that EBV is involved in MS, but no one seems to want to stick their hear above the parapet and say it. 30 years ago a friend had Bells Palsy and the neuro told asked her about her medical hisotry. My friend said that she had Glandular Fever tow years earlier. The neuro said that the virus (EBV) that behind Glandular Fever was thought to be linked to MS. 30 years on and we don't seem to be much further along in terms of proving the link. Shouldn't we hand the puzzle to virologists who are the experts relating to viruses? And shouldn't the immune system problems fall to immunologists? I feel that neurologists are trying to cover all the ground but might not be best placed to solve this riddle.

Aggressive MS therapies that target B cells, e.g. alemtuzumab, cladribine, high-dose cyclophosphamide (RevImmune), mitoxantrone and autologous bone marrow transplantation, may be working by depleting the body of B cells infected with EBV. This is a hyppothesis that needs to be tested.

I agree a holistic model of MS causation needs to integrate the EBV hypothesis with vitamin D biology. This is something we are trying to do in the laboratory.

PML Risk Infographic

Holistic Management of MS ver. 7.0

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